SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes

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SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
SWHAP –
   14 Years of Championing
HIV and Wellness Programmes
    in Sub Saharan Africa

                          14

   Investing in Workplace HIV and Wellness Programmes:
     Good for Companies, Good for Employees, Good for
                Families and for Communities
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
A publication by the Swedish Workplace HIV and AIDS
Programme (SWHAP)
www.swhap.org

Indexing terms:
HIV/AIDS
Workplace Programme
Africa

ISBN: 978-91-86507-36-7 (print) 978-91-86507-37-4 (electronic)

© Swedish Workplace HIV and AIDS Programme (SWHAP)

Published with financial support from the Swedish International
Development Cooperation Agency (Sida). The opinions expressed
in this report are those of the authors and do not necessarily
reflect the views of the financiers.
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
Contents
Introduction .................................................................4
       Support for the Sustainable Development Goals ..................7

SWHAP Programme Overview ..............................8
       The SWHAP Model .................................................................................... 8
       SWHAP Impact ..........................................................................................10
       Key Success Factors ................................................................................12
		SWHAP Networks ...................................................................................... 14
		Capacity Building ...................................................................................... 14
		              Supply Chain and Mentorship Models ........................................ 14
		              Promotion of Gender Sensitive Workplaces and
                Communities ............................................................................................... 15

Good for Companies .............................................. 16
       Why invest in wellness - Snapshot Business Case and ..........
       Reputational Gains ..................................................................................16

Good for Employees ............................................... 22
       Unions and their Contribution to Successful Workplace
       Programmes.............................................................................................................. 24

Good for Families .................................................... 32

Good for Communities .......................................... 35

A Huge Thank You! .................................................. 41

                                                                                                                                     3
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
Introduction
    Globally, 36.9 million people were living with HIV
    at the end of 2017 (WHO); approximately two
    thirds of them were in sub-Saharan Africa, making
    addressing HIV and AIDS a key priority for the
    region. Because HIV affects people in the
                                                                It is estimated
    most economically productive period of                      that the medical
    their lives it results in reduced earnings                  expenses and lost
    and higher spending on medical costs                        productivity cost of
                                                                ill workers account
    with a knock-on effect on savings and
                                                                for 10-15% of global
    disposable income. In addition to human                     economic output.
    suffering, HIV has the potential to cripple                 Global Wellness
    the working population, increasing                          Institute

    company costs and reducing output.

    The impact of the HIV epidemic is aggravated by a worldwide trend
    towards urbanisation and unhealthy lifestyles that have led to an
    explosion of non-communicable diseases (NCDs), which the World
    Health Organization projects will cost over US$30 trillion in the next
    20 years, threatening productivity as well as national development
    and economic growth.

    To protect their bottom line, and the long-term welfare of their
    employees, companies need to actively engage in risk management
    since the average full-time worker spends a third of their day
    at work. As such, the workplace has both the capacity and the
    opportunity to influ­ence the physical, mental, economic and social
    wellbeing of employees and, in turn, the health of their families and
4   communities – it is an ideal arena for promoting health.
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
For over fourteen years, the Swedish Workplace HIV and AIDS
Programme (SWHAP) has demonstrated the effectiveness of public-
private partnerships in improving wellness and productivity in the
workplace. SWHAP provides catalytic support to com­panies to
develop and implement workplace HIV and wellness programmes
that address employees’ health needs, based on close partnership and
cooperation between management, employees and trade unions –
resulting in healthier employees and more productive companies.

This booklet shares a few of the many examples on how wellness
programmes using the SWHAP approach reduce HIV impact, while
improving productivity and employee satisfaction and loyalty.

  14 years of SWHAP has resulted in:

      ll Healthier workplaces and increased productivity.
      ll Development of diverse, inclusive and gender sensitive
         workplaces reducing employee turnover and positively
         impacting unemployment and skills development.
      ll Establishment of a better dialogue climate at the
         workplace, reducing stigma and conflict – influencing
         and improving the general work environment.
      ll Protection of the human rights of workers through
         implementation of anti-discrimination policies and
         information and awareness raising, on these and other
         related policies.
      ll Highlighting of sustainability as a core operational
         condition for companies and employees.
      ll Improved understanding of sexual reproductive health
         and rights (SRHR) and enhanced access to SRHR services.
      ll Creation of networks connecting companies from diverse
         countries and sectors for peer to peer exchanges on
         workplace disease management and sustainability
         strategies. The networks have made SWHAP an
         attractive partner for private sector engagement on HIV.
         Consequently, SWHAP contributes to national response
         frameworks in various countries.
      ll Contribution to social dialogue at national level between
         unions and employer associations.
                                                                       5
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
6
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
Support for the Sustainable
Development Goals
SWHAP also exemplifies a responsible private sector contributing
to sustainable development, as workplace wellness programmes:

    ll Contribute to good health and employee wellbeing.
       Health programmes also extend to families, communities,
       and the value chain of companies providing information,
       testing opportunities and access to healthcare.

    ll Mainstream gender into policies and regulations at the
       workplace and ensure that gender is a consideration
       and application in all business decisions, management,
       operations and sustainability strategies.

    ll Increase productivity and business efficiency essential
       for economic growth and more job opportunities.
       Programmes are also run through representative
       committees consisting of management, workers and
       unions using social dialogue to address relevant issues
       and protect interests and rights of all parties.

    ll Offer public-private partnership with scalable catalytic
       financial support to establish the programmes and
       decrease risks. Partnerships are established to lower costs,
       increase reach and spread the impact of the programmes.
       Through networks and peer-to-peer exchanges companies
       can collectively share experiences and address common
       challenges.

                                                                      7
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
SWHAP Programme
               Overview
               SWHAP is a public private partnership established by the International
               Council of Swedish Industry, NIR, and the Industrial and Metal Workers’
               Union of Sweden, IF Metall, and co-financed by Sida. It is a long-term
               strategy to contribute to the establishment and/or support of HIV and
               wellness management programmes in workplaces across sub-Saharan
               Africa.

               SWHAP aims to benefit companies, employees and their families, as well
               as the wider community. This helps ensure the sustainability of wellness
               programmes and improves community wellness.

               At the time of inception, in 2004, there were very few examples of public-
                                  private partnerships addressing HIV and AIDS in the
SWHAP PARTNERS                    workplace and the objective of the programme was
REDUCE HIV                        to bring those affected together to share experiences
Research from SWHAP South         and ideas on overcoming the business challenges
Africa showed that:               created by the AIDS pandemic.

    ll HIV prevalence
       dropped by   0.7%
       between 2012 and           The SWHAP Model
       2016
                                  The SWHAP model is a partnership model that uses
    ll Very few employees         social dialogue as a method where management and
       who previously tested      workers’ representatives together take responsibility
       nega­tive later tested     for the design and implementation of the workplace
       positive                   programme. This increases ownership at company
    ll Most HIV positive          level providing motivation for further investments into
       workers were               workplace wellness.
        productively
                                  SWHAP has identified eight common steps in the
        employed and
                                  implementation of programmes that most companies
        enrolled on employee
                                  go through. This is, however, not prescriptive, as
        support programmes.
                                  support is tailored to recognise the different contexts
                                  and challenges faced by the companies.
    8
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
The SWHAP Model

           Management and                                                        Peer Educator
         employee ownership                                                        Programme
             and partnership

                                         Employee Assistance
                                                Programme

                                  Family and                      Share, coach
                                  community                        and mentor
                                    outreach

SWHAP provides:

   ll Technical support.
   ll Networking platforms for companies and partners to share
      experi­ences and materials.
   ll Templates, tools and case studies that help partners with
      workplace wellness management.
   ll Financial and technical support for supply chain programmes
      that contribute to a healthier business chain.
   ll Mentorship programmes for unions and employers’
      organisations that build their ca­pacity to respond to
      members’ wellness needs.

SWHAP Support

        Financial and technical
         support to workplace
                   programmes

                                               Supply Chain and
                                                     mentoring
                                                   programmes

                                                                                      9
SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
Programme Sphere of Influence Over Three Year Period

   Year 1& 2 - Family
Involvement of families in
      wellness days
  Spousal programmes

                                          Community

                                             Family

                                                                             Year 3 -Community
                                                                            Interventions for value
                                                                             chain, neighbouring
                                                                              communities & key
                                          Workplace                              populations

    Year 1 -Workplace
Establishment of baselines
     Capacity building
   Set up of programme
         structures

                     SWHAP Impact
                     Since 2004, when the Programme was launched in 10 companies
                     in South Africa, SWHAP has grown annually both in terms of the
                     number of workplaces supported and the countries with SWHAP
                     presence. In 2017, over 500 workplaces from 11 countries benefitted
                     from participation in the programme. According to testimonies from
                     the companies, the programme has led to changes in culture at the
                     workplace, including reduced stigma and behaviour change.

        10
SWHAP in 2017

 An Economic Evaluation of the SWHAP South Africa programme
 by Karolinska Institutet in 2018, produced the following results:

     ll A return on investment analysis showed that among
        1,000 employees and at an annual cost of ZAR 300,000,
        an average of 20.84 HIV infections per year will be
        averted: 7.27 among employees and 13.57 among their
        sexual partners.

     ll A net benefit analysis shows that funds invested in
        the programme, result in absolute cost-savings of ZAR
        134.42 per employee.

     ll The estimated benefit cost ratio suggests that for every
        Rand spent, the employer can expect to benefit by ZAR
        1.45: a 44.8% return on investment.

                                                                     11
Key Success Factors
     This section details some of the most important elements of SWHAP’s
     success.

     Partnerships
     The emphasis on partnership between unions, employees and
     management is a critical aspect of the programme. It results in more
     effective workplace programmes with greater buy-in at all levels of the
     workplace, which contributes to improved dialogue and strengthened
     industrial relations both within companies and in society in general. In
     2017, partnership with unions resulted in an additional 74 workplaces
     establishing HIV and wellness programmes.

     Cost-Sharing Model
     The workplace programmes are financed by the companies and by
     Sida through a co-funding mechanism, where the companies pay 40-
     60% on a sliding scale over three years. This means after three years,
     the companies finance the majority of the programme.

     This co-financing mechanism has reduced the risks professed by
     managers about the perceived costs of workplace programmes and
     creates a strong element of sustainability. In fact, only one company
     out of 166 has left the programme.

                                              = 10% SWHAP (Sida)
                                              = 90% Private Sector

                                                   99% of
                                                   company
                                                 programmes
                                                continue after
                                                 co-financing

              Company investments in workplace programmes
              SWHAP programme catalytic investment.

12
A Rights-Based Approach
Programmes are based on mandatory HIV and wellness policies that
ensure the confidentiality of employees’ HIV status, protect against
discrimination, and promote gender equality. Workplaces report that
prior to programme implementation, many workers did not want to test,
fearing that a positive result would risk their employment. The right to
confidentiality is now well respected amongst companies and has also
promoted trust between management and employees.

                                                 Summary Impact
      150
            Number of Companies

      100
       50
        0

                                     Policy        Training           VCT           Staff have
                                  implemented    programme          provided      access to ARV
                                                   in place

                                    Before SWHAP 2004

                                    Implemented through SWHAP by 2015 (including supply chain
                                    and mentorship companies)

A Wellness Approach
SWHAP encourages wellness management, which is a broad approach
to dealing with HIV and is shown to reduce stigma, encourage trust, and
lead to more effective workplace
programmes. Companies have                                          Communicable
                                                                      diseases
demonstrated that wellness                           Financial
                                                                                                            NCDs
                                                    Management
tests that include HIV testing and
counselling (HCT), increase uptake by
de-stigmatising testing. Additionally,      Stress
                                                                                                                   SRHR & gender
                                          management
wellness management addresses
                                                               Wellness Management
related diseases, lifestyle, and societal
issues that can either contribute
to the spread of HIV or affect those                                                                           Tuberculosis

living with HIV disproportionately.

                                                                                    HIV/AIDS      Malaria

                                                                                                                      13
SWHAP Networks
                    SWHAP uses networking as a relatively low cost means to maintain
                    programme momentum within different key groups in the workplace
                    programme, for example; CEOs, Peer Educators and Steering
                    Committees.

                                        Networks:

SWHAP NETWORKS                          ll Sensitise CEOs and senior level managers
                                        on the business case for workplace wellness,
                                        seeding sustainability.
               Number of network
   211         sessions held in 10      ll Support cost sharing activities and build
               countries since 2014
                                        capacity in programme planning, budgeting,
                                        implementation, monitoring and evaluation.

                                        ll Allow sharing of experiences that promote
% of participants who
                                        replication of programme successes.
rated networks            80%
as useful in 2017                       ll Provide technical support to companies and
                                        communities to better respond to the often-
                                        rapid changes in the epidemic.

                    Capacity Building
                    Key to the sustainability of the workplace programme is company
                    ownership. In order to support ownership, SWHAP provides internal
                    capacity building for management representatives, Peer Educators
                    and Steering Committee members. In 2017, out of the 1,129 active
                    Peer Educators, 74% enhanced their knowledge on SRHR, programme
                    implementation strategies, gender norms transformation, and NCDs
                    through network meetings and training workshops. Such training
                    reduces over reliance on external facilitators to run programmes and
                    supports external mainstreaming of programmes at community level.

                    Supply Chain and Mentorship Models
                    Companies that have set up HIV and wellness programmes are
                    encouraged to share their experiences with their value chain through
                    SWHAP Supply Chain or Mentorship Programmes.

                    These encourage the sharing of HIV and wellness knowledge, skills,
                    and experiences through the principles of mentorship, participatory

       14
learning, networking and on-going support. Mentor companies take
the lead in implementing the programme. They are responsible for
coordination, logistics, mon­itoring and evaluation, and liaison with
service providers to support training and testing for HIV, and other
medical conditions. SWHAP has found this strategy a cost-effective
way to reach multiple workplaces. In 2017, 175 workplaces were
supported to reach more than 16,000 workers with HIV and AIDS
information, develop policies, build capacity amongst Peer Educators
and steering committee members, and to conduct HCT.

Promotion of Gender Sensitive Workplaces and Communities
Gender inequality and harmful gender norms are associated with the
spread of HIV and its consequences – making integrating gender into
HIV and AIDS responses essential. SWHAP promotes gender equity
in workplaces and communities using three approaches: gender
mainstreaming and diversity management; targeted gender activities
(addressing specific issues related to gender); and gender-aware
dialogues. These initiatives are helping to ensure that both men and
women access comprehensive HIV prevention treatment, care and
support services. At male dominated workplaces, the involvement of
spouses and families through spouse peer education programmes,
wellness days, couples testing and training on SRHR is transforming
gender relationships and promoting gender equity at both workplace
and community level.

                                                                        15
Good for Companies
         If you could say one thing to business leaders about
         workplace programmes, what would that be?
         “This [workplace programme] is not a welfare issue, it is a business
         issue. Healthy employees produce at their best. People want two
         things; health and wealth. Help them take care of their health, and
         wealth will come to both parties. If your employees are not healthy
         you are losing on your bottom line”. Divine Ndhlukula, Managing
         Director, Securico Security Services, Zimbabwe

     Why invest in wellness –
     Snapshot Business Case and
     Reputational Gains
         Wellness – the Business Case

         HIV and AIDS may cost companies between 2% and 6%
         of salaries per year in direct costs for healthcare and other
         employee benefits, and indirect costs for absenteeism (illness and
         funerals), lost skills, training and recruitment costs, reduced work
         performance and lower productivity.

         In South Africa, the estimated cost of lost productivity due to
         depression is US$17 BILLION – of which US$14 BILLION is down
         to presenteeism1.

         IN CONTRAST

         HIV programmes reduce risk and pension fund contributions, far
         outstripping the cost of the HIV programme itself.

         Wellness programmes are associated with a 14% increase in
         employee satisfaction & reduced staff turnover2

         Employees with higher levels of wellbeing are up to 3 X MORE
         PRODUCTIVE than their less healthy colleagues3

     1 Evans- Lacko, S. & Knapp, M. Soc Psy­chiatry Psychiatric Epidemiology (2016) 51: 1525
     2 Union for Internation­al Cancer Control, Cancer it’s Everyone’s Business
     3 World Economic Forum (2010b), The Wellness Imperative - Creating More Effective Organizations

16
Value for Companies

      Employee wellness programmes:
      ll Improve recruitment and retention of skilled staff,
         reducing staff turnover.
      ll Reduce absenteeism and the negative effects of
         presenteeism.
      ll Improve workplace productivity.
      ll Improve job satisfaction and employee morale.
      ll Foster organisational commitment.

Unacknowledged ill health among employees, presenteeism (where
the employee is present at work but not able to fully contribute) and
increased sick days can be major contributors to lost productivity.
Additionally, there are knock- on effects on medical, pension and life
insurance contribution costs.

A sustainable wellness programme can create a positive impact on
society and the environment, which in turn, positively affects the
company’s financial bottom line and generates shared value.

                                                                         17
Increasing Pension Fund Contributions with HIV
     Workplace Programmes – Atlas Copco South Africa

      Atlas Copco created its HIV and AIDS workplace programme in
      2002. By the following year, the basics of the Programme were in
      place and the company offered its first HIV counselling and testing
      activity. The first person to get tested for HIV was the then CEO.
      This gave confidence for everyone else at the company to test, and
      as a result, 96% of employees got to know their HIV status. Since
      then, Atlas Copco has established a successful and sustainable
      programme built on the involvement of both workers and
      management in creating the trust needed around the programme.

      Achievements:

          ll The impressive results of the programme convinced
             Atlas Copco’s death and disability insurance
             provider to lower its premiums. These savings of ZAR
             1 million have been invested in increased pension fund
             contributions, benefitting all employees and creating a
             powerful incentive for continuous engagement in the
             HIV workplace programme.

          ll Other less tangible benefits are reduced sick leave and
             lower staff turnover (due to fewer deaths), which lower
             recruitment and training costs.

                                 “Collaboration with the SWHAP
                                 Network has not only resulted in
                                 a more creative and sustainable
                                 programme but given the Company
                                 the impetus to challenge service
                                 providers to provide better data,
                                 benefits and savings to our staff.”
                                 Wendy Buffa-Pace, Corporate Human
                                 Resources & Communications
                                 Manager, Atlas Copco
18
Savings on Group Life Cover and Pension Premiums Equal the
Cost of the Programme – Ericom Communications Zimbabwe

 Since 2007, Ericom Communications have only lost one worker
 to an AIDS-related death. This is in sharp contrast to 2000, prior
 to the implementation of their workplace HIV and wellness
 programme, when in one year the company lost five experienced
 technicians from the same department.

Achievements:

   ll As a result of a well-functioning HIV programme and high
      HCT-uptake, Ericom Communications Zimbabwe’s Group
      Life Cover and Pensions Fund Administrator reduced
      contributions for current active members from 4.2% (USD
      1,703) to 2.2% (USD 892), saving Ericom close to USD 10,000
      per year – greater
      than the cost of the
      HIV programme.

   ll Following social
      dialogues, company
      management also
      identified gaps
      in gender and
      diversity and
      instituted in-house
      drama sessions,
      which created
      safe spaces to
      address a wide range of health-related issues including the
      relationship between gender and HIV.

   “Workplace HIV and AIDS Programmes work.
   I have seen the evidence of this at Ericom.”
   Tellmore Chiramba, Peer Educator, Ericom Communications

                                                                      19
Inspired to do More to Manage Wellness in a Complex
     Environment – Sodeico Manpower, DRC

      When SWHAP was launched in the DRC in 2012, Sodeico, a
      specialist human resources firm was one of the first companies
      to join the programme. They had 2,000 agents placed in 46
      companies, operating in 77 locations, in all 11 DRC provinces.
      Agents came from varied social environments and did not have
      the same access to information on HIV. Before the partnership
      with SWHAP, there were several positive cases amongst agents,
      staff or their family members, of which the company was
      unaware; at times, it was only on the death of an agent that they
      would find out that he or she had died of an AIDS-related illness.

     Achievements:
        ll 18 Peer Educators were trained and were instrumental
           in breaking down the taboo surrounding HIV. As a result,
           Sodeico achieved an HCT uptake of 86% on their first
           screening.

        ll A disease management programme was established giving
           free access to counselling, treatment, care, and follow up
           services for employees and their families.

        ll A women’s wellness day was held for more than 200 female
           agents where HIV, reproductive health, and family planning
           were discussed.

20
ll The programme benefitted staff at all levels. Former CEO
   of Sodeico, Mbanzi Moupondo, tested positive for high
   blood sugar at the 2015 SWHAP conference. He was later
   diagnosed with diabetes and put on treatment; through a
   radical change in lifestyle
   and the support of his staff,
   he overcame the disease.

ll Sodeico is now in the process
   of diversifying its business
   and is investing in a clinic
   for both employees and
   people from the surrounding
   community. The investment
   will reduce Sodeico’ s
   healthcare costs by 50% –
   notable savings given healthcare costs in the country.

    “We learnt from SWHAP to see wellness and
    workplace programmes as a cost reduction
    strategy. I personally believe that without
    SWHAP, we would not have started looking
    at healthcare – the potential benefits, both,
    socially and economically.”
    Djo Moupondo, CEO, Sodeico Development

                                                              21
Good for Employees
     Getting to Zero using a wellness approach
     In 2015, Ericsson Uganda noted a decline in the number of employees
     participating in HTC, so the company extended their HIV programme
     to include wellness, allowing employees to check their body mass
     index, as well as test for diabetes and high blood pressure. Access to
     results was made available immediately after testing.

                                 Health risk profiling revealed that 20% of
                                 employees were overweight to obese,
                                 leading the company to implement
                                 targeted interventions including
                                 promoting nutrition, physical activity and
                                 stress management in conjunction with
                                 the existing chronic disease management
                                 programme.

                                 The company also collaborated with
                                 the Uganda Cancer Institute to raise
                                 awareness and provide cervical
                                 and prostate cancer screening for
                                 employees. At the wellness day following
     these initiatives, 91 members of staff participated in health
     screening and 88 were tested for HIV.

       Employee Benefits
       Ericsson noted the following benefits to employees:
           ll Convenient worksite screening and support
           ll Support in weight management
           ll Improved physical fitness and stamina
           ll Lower levels of stress
           ll Increased well-being, self-image and self-esteem
           ll Reduced healthcare costs.

22
23
Unions and their contribution
     to successful workplace
     programmes
     Unions are an important partner in ensuring engaged employees and
     the success of any wellness programme.

     An Employer/ Union Partnership in Kenya

     In Kenya, the transport sector accounts for more than 30% of GDP.
     Long distance truck drivers and their assistants, loaders, are an integral
     part of the sector and their health affects its profitability. However,
     their health needs are not always adequately met. In some areas, HIV
     prevalence for truckers is between 25% and 32%, which is, in many
     cases, more than double the national averages (kmcc.org.ug).

     In response to its members’ needs, The Kenya Long Distance Truck
     Drivers and Allied Workers Union (KLDTAWU) began offering
     roadside testing at sites along the Northern Corridor. While roadside
     testing provided convenient access to HIV and wellness services for
     the truckers, it failed to address the structural issues that were making
     them more vulnerable to HIV, sexually transmitted infections (STIs)
     and other health issues. A partnership with SWHAP, the International
     Labour Organization and the Federation of Kenya Employers
     (FKE), catalysed dialogue and networking between the union and
     employers, resulting in the expansion of the programme.

     Achievements:

         ll Comprehensive HIV workplace programmes were developed
            for 30 companies; 3000 employees tested for HIV and 6,090
            people were reached with health information.

         ll Policy development and standardisation of policies in line
            with ILO Recommendation No.200 of 2010, for 30 companies,
            ensuring a supportive environment for HIV positive workers
            and prevention interventions for those who were negative.

         ll HIV and AIDS management capacity built within SMES. Over
            100 management representatives were also sensitised on the
            business benefits of workplace HIV and wellness programmes.
24
ll Companies involved in the programme from Nairobi were
       incorporated into the FKE Human Resource Network Forum,
       helping management to keep abreast with developments
       relating to the management of HIV in the workplace and
       other industrial relations issues.

    ll The HIV and AIDS policy development process provided an
       entry point to engage transport companies on labour laws
       (for example on sexual harassment), contributing to the
       overall decent work agenda.

    ll The mentorship programme created forums for discussions
       on how unions and employer organisations can work
       together to address other industrial relations issues beyond
       Kenya’s borders – the Secretary General of KLDTDAWU is
       Chair of a regional truck driver’s association.

Unions are also taking up issues at national level to ensure legal and
policy changes.

         “We can contribute to changing the attitudes of the employers
         and our membership to a common understanding of the
         realities. HIV does not discriminate; it affects employees and
         management alike.”
         George Kalumbi Sikazwe, Director of Research, NUBEGW

The Zambia National Union of Building and Engineering and
General Workers (NUBEGW), with a membership of 11,805, including
Atlas Copco and Sandvik employees, has trained advocates to get HIV
and AIDS clauses included in collective bargaining agreements. The
Union has also drafted an HIV and AIDS policy for the sector.

In Zimbabwe, the National Engineering Workers Union (NEWU)
has been engaged in training sessions on the legal framework for HIV
and the development of workplace wellness programmes – building
capacity in 103 members from two provinces. The training is part of a
national sector policy dissemination strategy.
                                                                          25
In 2016, SWHAP and the ILO supported a partnership between NEWU,
     the Engineering Iron and Steel Association of Zimbabwe (EISAZ)
     and the Ministry of Public Service, Labour and Social Welfare for the
     development of a sector policy. The policy set out a framework for
     the prevention and management of HIV, AIDS, tuberculosis and other
     opportunistic infections for workers and their dependants. Workshops
     facilitated through these partnerships gave employers a clearer
     picture of how HIV impacts business, correcting previous beliefs that
     affected employees were careless – beliefs that fuelled discrimination
     in the workplace.

     SWHAP is also collaborating with the National Union of Metal
     and Allied Industries in Zimbabwe (NUMAIZ) to sensitise the
     Union’s focal persons on HIV and AIDS. NUMAIZ, an affiliate of the
     Zimbabwe Congress of Trade Unions (ZCTU), has around 9 000
     members in five sectors.

     The majority of the DRC’s socio-economic activities take place in
     the informal sector and an estimated “80% of the active population
     operates outside the labour market” (afdb.org). Partnership with
     SWHAP has helped La Confédération Syndicale du Congo, or CSC,
     have a positive impact on the informal sector in the DRC, where the
     union is working to promote social protection and decent work.

     Prior to the mentorship with SWHAP, the union conducted ad hoc
     activities on HIV and AIDS for its members. The training assisted
     CSC to formally integrate HIV under the union’s social protection
     objectives, enhancing its capacity to teach employees and members
     how to protect themselves against HIV and other communicable
     and non-communicable diseases. Through various associations that
     are members of CSC, over 800 taxi drivers, female market vendors,
     mechanics and those working in agriculture, were reached with
     information on HIV prevention and family planning.

     Within the formal sector, the union created structures in 29 member
     companies to improve health interventions and outreaches that were
     already being conducted. Steering committees and vibrant peer
     education programmes are now promoting positive behaviour change
     in workplaces and communities.

26
Mainstreaming Gender and Diversity Management –
An example from NUMSA
Gender mainstreaming allows workplaces to better plan and
respond to issues of gender and diversity, maximising the ability of
all employees to contribute to organisational goals. In 2015, SWHAP
piloted a programme to assist its partners with a more consistent
approach to gender mainstreaming of their HIV and wellness
programmes that is also integrated within other core areas of business.

The Gender Coordinators from the National Union of Metal Workers
of South Africa (NUMSA) were part of the programme. The SWHAP
partnership with NUMSA built capacity amongst the Gender
Coordinators to: organise social dialogues; raise awareness on HIV
and workplace programmes and benefits; develop an understanding
of gender and diversity management; and raise awareness on the
options for mainstreaming gender for business sustainability.

Olga Medupe, NUMSA Regional Gender Coordinator, explains how
she and the other gender coordinators put those skills to use.

                                                                          27
There was a transgender steward at one of the companies we work
             with. Stigma was rife and many of his colleagues did not want him
             in that role. Additionally, his management was not supportive. After
             attending the SWHAP gender and diversity mainstreaming training,
             we organised a workshop at the company to discuss the importance of
             diversity within the workplace and to promote dialogue. This resulted
             in reduction in stigma. The shop steward reported back to us saying
             that his work environment had improved and that colleagues were
             more understanding and treated him better. He was later promoted.

             In another workplace we had a female employee (only female
             employee in male dominated environment) who was forced to share
             the only changing room with male colleagues. She was at breaking
             point about to leave the company when through dialogue with the
             employers we persuaded them to set up a change room for women.
             The mainstreaming training gave us the skills to run workshops for her
             male colleagues and management at the company.

“The training has given me the confidence to articulate issues and skills
to promote dialogue.”

              Benefits of gender mainstreaming
                 ll A gender diverse workforce provides easier access to
                      resources, such as various sources of credit, multiple
                      sources of information, and wider industry knowledge.
                  ll A gender diverse workforce allows the company to serve
                     an increasingly diverse customer base.
                  ll Gender diversity helps companies attract and retain
                     talented women.
                  ll Addressing gender inequalities removes barriers to
                     accessing HIV services, enabling women and men to
                     access comprehensive HIV prevention, treatment, care
                     and support services.

 28
Peer Educators in the Workplace
Peer Educators are a mainstay of HIV prevention in many developing
countries and are supported to promote health-enhancing change
among their peers and community by sharing health information,
values and behaviour.

For SWHAP, Peer Educators are an important link between
management and employees and encourage employee trust and buy-
in to wellness programmes.

Peer Educators also encourage openness about the risks of HIV
transmission within long-term relationships.

  Value for Peer Educators

      ll Peer Education training has an enduring effect that
         goes beyond the workplace. Learning transcends the
         workplace and benefits friends and family.
      ll Some Peer Educators leverage the experience to make
         career advancements.
      ll Peer Educators become an asset to the company as they
         apply their new competencies within the company.

                                                                     29
Raising Awareness Among Spouses - Sympathy Chikukwa, Scanlink, Zimbabwe
Scanlink is a male dominated workplace, and Ms Sympathy Chikukwa is the only female
auto electrician. When she became a Peer Educator she realised that a lot of women were
left out of the workplace programme. Working with other Peer Educators, she began
to organise spousal trainings, where the wives of Scanlink employees were invited and
subsequently learned about HIV, prevention, treatment and wellness. After speaking to
the women at these events, Sympathy and
her fellow Peer Educators realised that a lot
of their information had not been reaching
women previously. At the HIV, Counselling
and Testing following the spousal training,
uptake increased.

By talking to the spouses of employees,
Sympathy and her co-Peer Educators raise
awareness as well as empower women with
the knowledge and tools to talk to their
husbands about the previously unthinkable
topics of sex and sexuality. Sympathy
illustrates this with an anecdote of a time that she told the wife of one of the employees
whom she was teaching how to use a condom. She was surprised, saying, “Look, what are
you teaching him? So you’re teaching him to be loose?” Sympathy recalls.

She then explained to the wife that condoms are one of the tools against the spread of HIV
and that there is nothing wrong with talking about sex and sexuality, I said: “Look, you might
not want to talk with him about it, but I talk to him about it every day” and she realised that if
her husband talks about it with another woman at work then she can also do it.

Peer Educator Impact in the Workplace - Babcock Ntuthuko
Babcock Ntuthuko Fabrication, in Jet Park, South Africa, has a culturally diverse work
force of 65. Between them, the employees speak five different languages with varying
levels of literacy. Diverse cultural and religious beliefs as well as language barriers
affected information dissemination and employee engagement in the workplace
wellness programme. The peer education team, led by Eugene Penny, responded to
these challenges by organising an inclusive wellness week that increased employee
engagement. The wellness programme improved employee willingness to approach
Peer Educators with health-related queries.

       30
Achievements:
   ll All employees have access to regular HIV and biometric screening, disease
       management and support services, along with HIV and wellness education and
       testing.

   ll Employees were educated on the dangers of smoking and drinking, promoting
      self-awareness and appreciation of their health and financial implications.

   ll Employee access to nutritional information and healthy eating was improved
      at minimal cost through competitions encouraging the creation and sharing of
      healthy recipes.

   ll Promotion of dialogue in the workplace contributed to improved interaction
      across the culture, language and economic divide. The dialogue also started
      addressing some of the negative cultural practices that hinder health seeking
      behaviours.

   ll The programme was recognised as a positive contribution to the company staff
      retention initiative.

  “At normal workplaces, time is not given to focus on employee health
  in a practical manner: you come in to work. This was different in-
  depth information. Everything came together during the wellness
  week. Employees recognised that handwashing, TB, HIV and
  nutrition are all interlinked. We understood the importance of good
  health for our ability to work, and that it prevents absenteeism.
  Otto’s [cancer survivor] testimony was really important for the
  young men. Simple interactions can help save lives in the long run.”
  Kelvin Mgrebe, Babcock Ntuthuko
                                                                            31
Good for Families
     The SWHAP programme does not stop only with ensuring benefits for
     companies and their employees; it also involves itself with the health
     of their spouses and children. Including families in the programme
     promotes uptake of testing, treatment, and supplementary nutritional
     support to affected families leading to greater openess and voluntary
     disclosure of HIV status.

       Wellness programme family activities include:
           l   Spousal Peer Education Training where spouses of
               employees are trained on HIV and AIDS and sexual and
               reproductive health and rights, enabling them to become
               behaviour change advocates and community psychosocial
               counsellors in their families and communities. This
               reduces the information gap between partners on HIV
               transmission, progression, prevention and management
               and increases the acceptability of workplace programmes.
               It also increases levels of HIV and AIDS information within
               the wider community; some spouses volunteer at local
               clinics reaching audiences that extend far beyond the
               workplace programme.
           l   Spouse Clubs where the mainly female partners of
               employees receive training in financial literacy, and technical
               and financial support on income generation opportunities.
           l   Family Wellness Days that intersperse sporting activities
               and games with HIV messaging, general health and HIV
               and biometric testing.
           l   Workplace-based activities to promote couples
               communication, testing and voluntary disclosure of HIV status.
           l   Youth life skills training for children, promoting delayed
               first sex and responsible sexual behaviour. Educating
               their parents also improved their communication skills in
               discussing issues around sex and HIV.
           l   Workplace policies that include benefits for spouses and
               other family members.
           l   Promoting gender mainstreaming through strategies
               and approaches that include spouses and communities.

       Between 2007 and 2017, 28,584 family members
32     participated in the programme
Supporting Testing for Couples

 Britos’ Story
 Britos Mapfumo worked with Sandvik Zimbabwe
 from 1973. He shares how he confronted and
 survived HIV, speaking passionately about how
 he fought to return to work and live a normal
 life with HIV. Today he is a wellness champion
 in his community.

 “I was employed as a machine worker for 32 years and found out
 my HIV status in 2005, after multiple complications. I was retired
 on grounds of ill-health and Sandvik assisted my spouse to also get
 tested. My wife and I received treatment and nutritional support
 from Sandvik for two years while I was on retirement. I have since
 regained full strength and was certified fit for work and re-engaged
 in November 2008. My advice to everyone is that they need to know
 their status and seek early treatment for ART to be effective.”

 Now aged 64, Britos has finally retired and looks forward to a long
 and fulfilling retirement.

                                                                        33
Spousal Peer Education Training

                         Lillian’s Story
                         Lillian Chanda, Chairperson of the Women’s
                         Spousal Group at SKF Zambia, nurse and
                         mother of six, explains why she became a
                         Spouse Peer Educator.

                         “I have always wanted to support colleagues
                         to cope with the different challenges they go
                         through in life. My husband works at SKF, which
                         has a comprehensive wellness programme. I
                         joined their Spousal programme and this was my
                         chance to be a cornerstone of change for myself,
                         my family and my community.

                           This was the beginning of my journey to become
      nurse-midwife which has provided my family with an additional
      source of income. The meetings I attend with other spouses offer me
      additional training and have deepened my understanding. At the
      clinic, I conduct health sessions in the antenatal department and
      share the topics we learn
      as Peer Educators. It is
      very satisfying to counsel
      couples on issues
      around HIV: you chat to
      a woman who comes
      alone and the next time
      she come together with
      her partner.

      On a personal level,
      the information on
      couples communication
      has helped in our
      home. Now we value open communication and we are happier. We
      communicate easily and my children have also embraced wellness;
      we take care what we eat and exercise regularly.”

34
Good for
Communities
Once a workplace is implementing a sustainable workplace wellness
management programme it is encouraged to share its experiences
through initiatives such as supply chain programme and mentoring.

Supporting the Value Chain

  Sandvik Zimbabwe partnered with SWHAP in 2007 and over the
  years, has developed a successful in-house as well as community
  response to HIV and Wellness. In 2010, Sandvik ran their first
  Supply Chain Programme by mentoring seven companies
  to develop and strengthen their workplace policies and
  programmes. The mentorship paid dividends with partners such
  as Freda Rebecca gold mine, where programmes became more
  participatory. Prior to Sandvik’s mentorship, HCT uptake at Freda
  Rebecca was very low and there was a high rate of sick leave due
  to opportunistic infections; a seroprevalence survey found the
  mine’s HIV burden to be 13.7%.

Achievements:

    ll Reduction in seroprevalence of 3.1% between 2011 and 2014.

    ll Approximately 35% reduction in absenteeism due to HIV/
       AIDS related illness.

    ll HCT uptake improved by 50.5% after mentorship process.

    ll The mine Wellness Centre was also registered as an
       antiretroviral treatment centre and most employees
       transferred from the national hospital Opportunistic
       Infections clinic to the on-site clinic, reducing lost man-
       hours as employees avoided long queues.

    ll Freda Rebecca Mine later became a runner-up for the SWHAP
       Achievement Award for Best Progress in 2016. Today over
       80% of employees know their HIV status.
                                                                      35
“The partnership with Sandvik and SWHAP played a very vital role in
     improving the Freda Rebecca Gold Mine Wellness standards. This is
     reflected through increased worker retention, increased access to HIV
     and AIDS services, reduced absenteeism due to HIV related sickness,
     increased responsiveness of company management to the needs
     of HIV positive workers and improved observance of workers’ rights
     based on gender.” - Sister John, Sister in Charge, Freda Rebecca
     Gold Mine

36
Community Outreach Initiatives Changing Lives
Community outreach encouraged by SWHAP enables companies to
reach out to high risk groups such as youth, and develop community-
wide positive social behaviours and risk awareness. SWHAP networks
across the region engage with local communities and networks of
people living with HIV, assisting where they can. The majority of the
outreach activities are conducted by Peer Educators who extend the
reach of wellness programmes into communities leading to provision
of innovative assistance.

Naomi’s Story
Peer Educators from the Kenya SWHAP network were visiting the
Kenya Network of Women Living with HIV/AIDS (KENWA) Children’s
Home as part of the annual International AIDS Day celebrations, when
they met Naomi Kimani.

“I have been HIV positive since birth. My parents passed on when I was
very young. When I learnt about my status, I decided that it would not be
a limitation for me.”

Naomi had been accepted into teacher education college, but had no
money to pay fees. The Peer Educators pooled their resources to pay
for her first semester fees and Atlas Copco subsequently took over.
In June 2017, Naomi graduated with a Diploma in Education and
started teaching maths, science and English at a school in Muranga
County Kenya.

                                                                            37
Soon afterwards, she started a support group for young people living
     with HIV that is having a positive impact on young people whose
     parents are employed amongst companies in the SWHAP network.

      “Our activities are mainly mentoring young adolescents who are on
      care and especially those in boarding schools to ensure they adhere
      to their medication. We also visit children’s homes to encourage HIV
      positive youth that there is a future for them.”

                                                 Naomi is optimistic about
                                                 her future.

                                                 “2018 started with a lot of
                                                 blessings. I was promoted
                                                 to deputy head teacher,
                                                 I got married and I am
                                                 expecting a baby. I am very
                                                 positive that my baby will
                                                 be born negative. I started
                                                 my antenatal care early in
                                                 the pregnancy and I have
                                                 adhered to my medication
                                                 and all the instructions
                                                 given to me by my doctor.

      I want to encourage anyone who feels that all is lost when you test
      positive. Life moves on my friend. It is just a simple condition, which
      is manageable if you adhere to medication and choose to have a
      positive outlook. I have been positive since birth but I am now 24 and
      making it in life with my own family.”

       Between 2010 and 2017, Peer Educators reached
       over 84 000 people outside the workforce with
       information on HIV and wellness

38
Mirelle’s Story
Mirelle lives in Katanga and works with the CSC as the
Focal Point for HIV and Informal Sector reaching out to
informal sector workers. Troubled by the lack of access
to healthcare for the people in her community, Mirelle
wanted to do more to bridge the gap.

  “I was struck by how isolated people working in the
  informal sector are, and how little access they have to
  health information and services, yet their work and
  lifestyle often put them at greater risk of ill health or
  HIV infection.

  I was really motivated to get involved after attending
  the SWHAP conference in 2015, and registered a
  foundation to sensitise people on family planning,
  marriage counselling, prevention of communicable
  diseases (HIV, malaria, TB) and diabetes. People in
  the community did not know about birth spacing or
  HIV and many women who had been raped were testing
  positive for TB.

  Knowing the link between HIV and TB, I wanted to encourage them to get tested for
  HIV. Through partnerships with other organisations we were able to get access to post-
  exposure prophylaxis (PEP) for rape survivors and so far, we have distributed PEP to 50
  people and provided access to family planning services to 200 people. We have also
  received support to build a maternity wing.

  To help address poverty in the community, our services evolved to include vocational
  training helping people learn skills that would provide better employment or income
  generating opportunities, while improving their access to healthcare services. We train
  about 50 people every month and have trained 315 people since 2016.”

  What motivates you?

  “I think this is a calling. When I was younger I wanted to be a nun,
  but my family refused and forced me to get married at a 17 during
  the time of the rebellion war with Rwanda. I am fortunate to have a
  great team that runs the foundation allowing me to carry on with
  my work at CSC.”
                                                                                   39
Companies Supporting Community Life Skills
        ll Metso South Africa, is implementing a life skills programme
           including age appropriate information on SRHR for
           adolescents at an SOS village.

        ll Sandvik Tanzania has reached 156 boys and 10,000
           spectators with information on HIV and healthy
           lifestyle choices through high volume sports intervention
           programmes.

        ll Scania conducted road shows targeted at truck drivers in
           partnership with SWHAP and other stakeholders, providing
           information on HIV and AIDS to a hard to reach and high-risk
           group, and breaching what is considered a taboo subject for
           many in the sector.

        ll Shreeji Chemicals, a mentee company of Raffia Bags, Kenya,
           have mobilised campaigns heightening awareness of gender-
           based violence in the community, reaching 500 people
           from 150 households with information on GBV and the
           importance of HIV testing.

        ll Atlas Copco has also been enthusiastic in sharing their
           experiences through enhanced community outreach as in the
           Atlas Copco Zambia Spouses’ Association in Kitwe. Spouses
           of employees have been trained as Community Peer
           Educators and now provide HIV and AIDS information to rural
           and urban communities.

40
A Huge Thank You!
We would like to thank all our partners – workers,
unions, companies, other partner organisations and
our funder Sida, – for having the vision and courage
to join SWHAP and for contributing to its success in
the response to HIV, AIDS and Wellness.

While HIV continues to have a big impact on the daily lives of many
people it is no longer the imminent threat to life and productivity it
was 14 years ago. Today we are better equipped to manage HIV as
a chronic condition and the social stigma surrounding the virus has
improved.

The workplace programmes participating in SWHAP are living proof
that partnerships based on mutual respect and inclusion are a
successful path to engage with the daily and future challenges faced
by companies. Workplaces and communities in sub-Saharan Africa are
now facing different challenges related to unemployment (especially
among the youth), non-communicable and lifestyle diseases, diversity
inclusion and gender inequality as well as industrial transformation.

We believe that the successes of the last 14 years and SWHAP’s unique
values of partnership, catalytic support, and using the workplace as a
change agent, will continue to improve health prospects throughout
sub-Saharan Africa and assist in finding solutions to any new
challenges.

SWHAP is now looking to the future and building on our experiences
to address common challenges and contribute to positive economic
and social development through continued partnership and
sustainable workplace programmes.

We look forward to continue this joint partnership with you.

                                                                         41
Together for Wellness
14

The Swedish Workplace HIV and AIDS Programme

General Programme Secretariat
Address: PO Box 555 45, SE 102 04
Stockholm, SWEDEN
Tel: +46 8 783 80 00
E-mail: info@swhap.org
Website: www.swhap.org

        company/swedish-workplace-hiv-and-aids-programme

        @SwedishWorkplaceHIVandAIDSProgramme

        @SWHAP_Sweden
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